原发于翼腭窝和涎腺的Ⅰ型神经纤维瘤病一例

患者男,19岁.因"左耳后结节6年"于2009年8月入我院.体格检查:左侧腮腺内和左侧颌下各触及一直径约2.5 cm和2.0 cm大小的实质性肿块,肿块光滑,质地中等,边界清晰,无压痛,活动轻度受限.CT提示左侧腮腺内2.5 cm大小的实质性肿块,左侧颌下腺内2.0 cm大小的实质性肿块,左侧咽旁间隙内一1.5 cm的实质性肿块,密度均匀,光滑,增强不明显(图1).术前诊断:左侧腮腺、颌下腺、咽旁间隙多发肿瘤,涎腺来源可能.     

原发于翼腭窝和涎腺的Ⅰ型神经纤维瘤病一例

患者男,19岁.因"左耳后结节6年"于2009年8月入我院.体格检查:左侧腮腺内和左侧颌下各触及一直径约2.5 cm和2.0 cm大小的实质性肿块,肿块光滑,质地中等,边界清晰,无压痛,活动轻度受限.CT提示左侧腮腺内2.5 cm大小的实质性肿块,左侧颌下腺内2.0 cm大小的实质性肿块,左侧咽旁间隙内一1.5 cm的实质性肿块,密度均匀,光滑,增强不明显(图1).术前诊断:左侧腮腺、颌下腺、咽旁间隙多发肿瘤,涎腺来源可能.     

60例咽旁隙肿块的CT及MRI影像学特征分析

目的探讨咽旁隙肿块的CT及MRI表现,了解其影像学特征。方法回顾性分析2014年6月~2016年6月收治的60例咽旁隙肿块患者的CT及MRI影像学特征,观察肿块的位置、形态、与周围组织关系、密度、信号高低等情况。结果在60例咽旁隙肿块患者中,神经鞘瘤36例、涎腺混合瘤15例、颈动脉体瘤5例、鼻咽癌颅底咽旁隙转移4例。神经鞘瘤表现为包膜完整、边界光滑、呈椭圆形或圆形的肿块,与腮腺深叶间分界清楚,涎腺混合瘤为包膜完整的圆形肿块,与腮腺深叶间没有脂肪间隙,茎突、二腹肌、腭帆张肌等周围组织均出现移位。颈动脉体瘤表现为形态规则的软组织肿块,CT平扫呈等密度、增强后明显强化;MRI扫描,T1W1呈等或稍高于肌肉信号,T2W1呈不均性的高信号,并可见流空血管影像。鼻咽癌颅底咽旁隙转移的MRI显示,T1W1呈低密度信号的椭圆形肿块,增强后高信号内可见坏死囊变区。结论正确地认识咽旁隙肿块的CT及MRI影像学特征,有助于提高其临床诊断率,为咽旁隙肿块的治疗提供一定的依据。     

副腮腺肿瘤临床分析

目的　探讨副腮腺肿瘤的临床、影像、病理特点及治疗效果。方法　收集并分析我院经治的8例副腮腺肿瘤病例资料。结果　多形性腺瘤5例,基底细胞腺瘤、多 形性腺瘤恶变（高分化非特异性腺癌）、高分化鳞状细胞癌各1例。良性肿瘤病例的CT表现为肿块呈椭圆形、边界清楚、密度均匀;恶性肿瘤病例的CT表现为肿块形状不规则、境界不清、密度欠均匀。8例患者均行手术治疗,入路分别选择：1例面颊部直接切口,2例口内入路,5例标准腮腺肿瘤切除入路,鳞状细胞癌病例同时行选择性颈清扫术。2例恶性肿瘤患者术后辅以放疗。所有患者治疗后随访1～5年,无复发及转移。结论　副腮腺肿瘤CT表现具有一定的特征性,彻底切除是首选治疗,入路宜选用标准腮腺切除切口,恶性肿瘤术后辅以放疗,短期疗效较好。     

婴儿右颈部巨大幼年型毛细血管瘤一例

患儿男,4个月,体重14kg,出生20d后发现右颈部肿块,随着患儿的生长发育,肿块也随之增大并影响颈部活动。体检:左颈部肿块约8cm×4cm×3cm,肿块上极达颌下,下极进入锁骨上窝,可听到血管杂音。触诊肿块质软,边界不清楚,肿块穿刺为血性液。血常规检查:血红蛋白95g/L,白细胞10·3×109/L。血清白蛋白39·4g/L。CT扫描:肿块5·6cm×5·2cm×6·0cm,肿瘤上极达咽旁间隙,下极进入锁骨上窝。增强扫描后肿瘤明显强化,内见斑片状低或无强化区,延时期见明显均匀强化(图1)。诊断:右颈部海绵状血管瘤。在全麻气管内插管下进行肿瘤切除术,取右颈部与胸锁…     

咽旁间隙肿瘤的诊断及手术入路选择

目的:探讨咽旁间隙肿瘤的诊断及手术入路的合理选择。方法:对45例咽旁间隙肿瘤患者的资料进行回顾性分析。患者均行CT及颈部彩超检查,部分患者行MRI或DSA检查。采用的手术入路分别为:颈侧切开入路35例,腮腺入路5例,颈颌入路2例,颞骨加腮腺入路3例。结果:45例患者中良、恶性肿瘤分别为37例(82.22%)和8例(17.78%),其中以神经源性及涎腺来源最为常见。应用CT、MRI和DSA明确肿瘤的位置、大小、形态、密度、强化程度及肿瘤与茎突和颈动脉的关系,作出术前诊断,其与术后病理诊断的符合率为80%(组织来源符合率)。37例良性肿瘤完整切除,1例淋巴管瘤术后1年复发,再次手术后无复发。8例恶性肿瘤中,2例为恶性混合瘤,1例随诊4年无复发,1例随诊3年,带瘤生存;2例滑膜肉瘤,1例随诊3年无复发,1例随诊2年无复发;1例鼻咽癌咽旁间隙转移,术后给予根治性放疗,随诊5年无复发;1例脊索瘤随诊3年,复发带瘤生存;1例低分化鳞状细胞癌随诊4年,死于肺转移;1例滤泡树突状细胞肉瘤随诊2年无复发;结论:CT、MRI和DSA对咽旁间隙肿瘤的诊断与鉴别诊断具有重要意义。颈侧切开入路简便、安全、创伤小,是咽旁间隙肿瘤手术的最...     

咽旁间隙肿瘤的诊断及手术入路

目的探讨对咽旁间隙肿瘤的诊断与手术人路的选择。方法对1984～2004年82例咽旁间隙肿瘤的临床资料进行回顾性分析。结果82例中良、恶性肿瘤分别占87.80％、12.20％。以神经源性(50％)及涎腺肿瘤(26.83％)最常见。手术采用口内径路8例,颈侧径路62例,颈颌径路9例,颈腮腺径路3例。结论颈部彩超及CT是诊断、鉴别诊断的良好手段,颈侧径路则是最常用而且安全的手术径路方式。     

鼻咽癌的CT诊断和鉴别诊断

目的总结影像学分析经验，提高鼻咽癌的CT诊断水平。方法回顾性研究32例经病理证实的鼻咽癌，着重就鼻咽癌CT影像特点、CT诊断及鉴别诊断进行分析。结果34例患者中，平扫CT片中全部出现咽隐窝变浅或消失，绝大部分病例显示病灶侵犯咽旁间隙及邻近组织结构，12例出现颅底骨质及颅内侵犯；颈动脉鞘区受累22例，颈淋巴结转移15例。增强扫描，病灶出现不同程度强化。结论根据典型的CT表现，一般不难做出正确诊断，鼻咽癌还需与鼻咽部其他肿瘤相鉴别。     

鼻中隔基底细胞腺癌1例并文献复习

目的：总结基底细胞腺癌的临床特点、诊断、鉴别诊断、治疗及预后。方法：回顾性分析1例鼻中隔基底细胞腺癌的临床资料,并进行文献复习。结果：基底细胞腺癌好发于大涎腺及硬腭等部位小涎腺,主要症状为局部肿块。治疗方式主要为根治性手术切除,必要时辅以放疗。结论：基底细胞腺癌为涎腺少见肿瘤,目前倾向于低度恶性,尚需大样本远期随访。     

上呼吸道硬结病的CT研究

硬结病是一种慢性特异性肉芽肿,用CT扫描可准确地估价硬结累及的范围。作者对37例硬结病病人行CT检查,均侵犯鼻部,17人有鼻窦及鼻咽部的损害,5人侵犯喉和上部气管,其中23人为肉芽肿期,其他病人为萎缩及纤维化期。其CT表现为:鼻、鼻窦和鼻咽部损害表现为小的粘膜结节或膨大的软组织肿块。害损为均匀一致,影象不增强且边界清楚。损害的多样性和鼻部受侵是上呼吸道硬结病的特征。在鼻咽部尽管肿物突出、鼻咽腔畸形但咽颅底筋膜不受累,即使有肌肉受累咽旁间隙仍正     

咽旁间隙肌上皮癌的影像学及临床病理分析

目的:探讨咽旁间隙肌上皮癌的影像学及临床病理特征。方法:分析我院收治的1例咽旁间隙肌上皮癌患者的影像学及临床病理资料,结合文献探讨头颈部肌上皮癌的临床特征。结果:影像学显示咽旁间隙占位性病变;病理学确诊为肌上皮癌,病理免疫组织化学表现为S-100蛋白、平滑肌动蛋白、细胞角蛋白、波形蛋白免疫组织化学阳性染色。临床表现为耳痛、流脓血伴头痛及脑神经损害。结论:肌上皮癌是罕见的预后极差的恶性上皮性肿瘤,好发于颌面部涎腺;发生于咽旁间隙并侵犯颞骨则表现为耳深部疼痛及头痛。影像学表现恶性肿瘤行为,破坏性强。病理免疫组织化学明确诊断。     

The significance of CT scan or MRI in the evaluation of salivary gland tumors

Imaging modalities such as CT scan or MRI are frequently employed for the diagnosis of neoplastic lesions in the salivary glands. To evaluate the efficacy of the CT scan and the MRI in differentiating malignant neoplasm from benign lesions, 120 CT scans and 31 MRIs were retrospectively analyzed from 147 patients with salivary gland masses. All images were analyzed focusing on the presence of several relevant features. The pathologic results were matched with radiological features and also tabulated with radiological assessment. For the CT scans, the contour and margin of the lesion and tissue plane obliteration were found to be statistically significant indicators for malignant neoplasms. Among 69 CT scans interpreted as ‘benign’ by a radiologist, five cases (7%) were histologically diagnosed as ‘malignant’. On the other hand, 20 out of 51 CT scans (39%) were misinterpreted as ‘malignant’. For MRI, two out of 14 cases (14%) were radiologically misdiagnosed as ‘benign’ and six out of 17 patients (35%) as ‘malignant’. In conclusion, whereas both the CT and MRI showed a similar level of accuracy in evaluation of salivary gland tumors, they showed a considerable tendency of misdiagnosis, especially by interpreting benign tumors as ‘malignant’.     

Surgical management of parapharyngeal space tumors

Despite its rarity, information on the diagnosis of parapharyngeal space tumors such as through imaging and aspiration biopsy cytology, is slowly accumulating. Little detailed examination has been conducted, however, on surgical approach, complications, and sequelae. We report the results of a retrospective review of 27 patients with primary parapharyngeal space tumors-25 with benign disease and 2 with malignant lesions-treated surgically. Surgical approach, postoperative complications, sequelae, and operative indications of parapharyngeal space tumors were examined in 28 operations on the 27 patients. Tumors found in the prestyloid region in CT or MRI are treated as salivary gland or malignant tumors. Those found in the poststyloid region are treated as shwannoma or paraganglioma. The transcervical approach is often used in patients with shwannoma, while a variety of approaches are selected for patients with salivary gland tumors. Complications occur in 50% of patients, however, bias based on pathological diagnosis has not been examined to the degree needed. Sequelae in our series occurred in 46.4% of our patients. Sequela in the patients with shwannoma, however, is 81.8%, compared to 9.1% in patients with salivary gland tumors. Prestyloid parapharyngeal space tumors seem to be "automatically" indicated for surgery, because the surgical risk is lower than the risk of inaction. In poststyloid parapharyngeal space tumors, however, it appears necessary to judge indication for surgery more carefully while considering the social background, age, and occupation of prospective surgical candidates.     

咽旁间隙肿瘤24例诊治分析

对 2 4例咽旁间隙肿瘤病人的临床表现、检查方法及手术前活检途径、诊治结果进行总结 ,提出以颈侧切开治疗咽旁间隙肿瘤为主的外科手术效果 ,并对手术后的并发症进行分析。     

原发性咽旁隙肿瘤的临床及病理分析

目的 研究原发性咽旁隙肿瘤的临床特征、诊疗方法、手术并发症及预后.方法 回顾性分析解放军总医院1994年1月～2005年12月收治的135例原发性咽旁隙肿瘤病例.结果 本组病例共包括24个病种,以神经源性最为多见(72.6%),其次为涎腺来源的肿瘤(15.6%),其他类型少见(11.8%),其中良性121例(89.6%),恶性肿瘤14例(10.4%).135例患者中,132例进行了手术治疗,其中最常用的手术入路是颈侧切开.11例手术的良性肿瘤患者中,4例术后局部复发.至随访期末,14例恶性肿瘤患者中5例(35.7%)死亡,5例患者带瘤生存(35.7%),4例患者无瘤生存(28.6%).结论 咽旁隙肿瘤较少见且多为良性,手术切除是主要的治疗方法.咽旁隙的良性肿瘤手术效果良好,恶性肿瘤预后较差.     

The value of fine-needle aspiration cytology in salivary gland lesions, 1994-2004

OBJECTIVE: Fine-needle aspiration cytology (FNAC) of the salivary gland is a commonly accepted, sensitive and specific technique in the diagnosis of both neoplastic and nonneoplastic lesions of the salivary gland. The aim of this study was to investigate the efficacy of FNAC of salivary gland lesions and to decide whether the radiologist could perform it or not. METHODS: We aspirated 162 salivary gland lesions of 56 patients undergoing biopsy and excision. A cytopathologist and a surgical pathologist made histopathological and cytological examinations in a blinded fashion. RESULTS: In the present study, among the FNAC performed in 162 patients with salivary gland masses, 15 (9%) were inadequate, and the remaining 147 were diagnostic. Of the 162 cases, 56 (35%) were also checked histologically. With FNAC there were 89 (55%) nonneoplastic and 58 (36%) neoplastic lesions. With FNAC 45 of the neoplastic lesions were benign and 13 malignant tumors. When cytohistopathological correlation was performed, the overall accuracy in diagnosing benign and malignant lesions was 91 and 78%, respectively, except for 2 malignant lymphoma cases. The sensitivity and specificity for benign and malignant lesions were 72 and 100%, respectively. The diagnostic sensitivity for all neoplastic and nonneoplastic lesions was 84% and the specificity 92%. There was 1 false-positive result, in which a nonneoplastic lesion was misdiagnosed as a Warthin's tumor. Fifteen (26%) cases were false-negative, 12 of which were undefined. CONCLUSION: FNAC is a useful and reliable tool in the diagnosis of salivary gland masses when performed by a radiologist or a clinician. There are no contraindications, and complications are minimal.     

Pediatric tumors of the parapharyngeal space. Three case reports and a literature review

Three cases of pediatric primary parapharyngeal space tumors, namely a Burkitt's lymphoma, lipoblastoma and a ganglioneuroma are described here, along with a literature review. These disorders are very rare, accounting for less than 20% of all parapharyngeal neoplasms. In comparison to adults, there are differences in pathomorphologic spectrum of pediatric parapharyngeal tumors. The authors describe the prevalence of malignant tumors, mainly soft tissues sarcomas. The salivary gland tumors and paragangliomas which dominate in adult populations, are extremely rare in pediatric populations where the most common benign tumor to be encountered is that of neurogenic origin. It follows that these features modify the diagnostic and therapeutic approach.     

Kaposi's sarcoma of an intraparotid lymph node leading to a diagnosis of HIV

OBJECTIVE: Kaposi's sarcoma is a common malignancy in patients infected with HIV but is rarely seen in the major salivary glands. If a patient is known to be HIV-positive, however, Kaposi's sarcoma must be considered in the differential diagnosis of salivary gland masses in addition to the benign and malignant neoplasms that occur in immunocompetent patients. We present a unique case in which an otherwise healthy patient was diagnosed with HIV after resection of his enlarged parotid gland revealed Kaposi's sarcoma. STUDY DESIGN: Case report. METHODS: A 58-year-old man presented with slowly enlarging bilateral parotid masses of approximately 3 years' duration. The patient's presentation, workup, and final diagnosis of Kaposi's sarcoma are discussed. RESULTS: A magnetic resonance imaging scan of the neck showed two right parotid lesions and one left parotid mass. The patient underwent a right superficial parotidectomy for a suspected diagnosis of Warthin's tumor, given the bilaterality of the lesions. Histologic evaluation of the surgical specimen revealed spindle-shaped cells with extravasated erythrocytes typical of Kaposi's sarcoma. After discussion of the results with the patient, HIV risk factors were elucidated, and subsequent testing revealed the patient to be HIV-positive. CONCLUSIONS: Although Kaposi's sarcoma is common in AIDS patients, there are few case reports of this malignancy arising in the salivary glands. Previously reported cases include salivary gland Kaposi's sarcoma in known HIV-positive patients and a handful of reports in patients without confirmed immunocompromise. The patient presented here is unique because the diagnosis of parotid gland Kaposi's sarcoma led to a new diagnosis of HIV. This interesting case reiterates the need for complete history taking and the inclusion of Kaposi's sarcoma in the differential diagnosis of salivary gland masses in the appropriate patient population.     

The incidence of neoplastic versus inflammatory disease in major salivary gland masses diagnosed by surgery

What is the incidence of non-neoplastic disease when dealing with masses of the major salivary glands? A knowledge of this information would aid the physician in making decisions relative to the management of the masses. Furthermore, the expected malignancy rate may need to be adjusted according to the findings of this study. Many reported series of salivary gland neoplasms show the relative incidence of benign vs. malignant neoplasms; however, not every patient with a mass of the salivary gland who comes to surgery is finally diagnosed as having had a neoplasm. Knowing the relative incidence of neoplastic vs. non-neoplastic salivary gland diseases has important diagnostic, therapeutic, and prognostic implications. Records of all patients who underwent either a parotidectomy or submandibular gland excision from 1975 to the present at the Eye and Ear Hospital of Pittsburgh were reviewed; 73% of the parotidectomies performed were done for neoplastic disease. A patient with a parotid mass has a likelihood of 1:10 of having a malignancy. Similarly, on a population basis, 1 submandibular mass in 12 will be malignant.